Questions about refugee health are Answered
By Bobbi Mlynar
Originally published 12:15 p.m., November 27, 2007
Updated 12:15 p.m., November 27, 2007
The following questions have been asked by area residents who were concerned about health and financial issues involving the Flint Hills Community Health Center/Lyon County Health Department and its dealings with refugees from Somalia.
Q Are the refugees screened in any meaningful way? Who does the screening?
A “Screening happens in a couple of ways,” said Lougene Marsh, executive director. “There is a health screening that’s done before they enter the United States. And then there is also a (refugee health assessment) that happens once they arrive.”
Screenings also are done by Marsh’s department, if proof of a refugee health assessment cannot be provided by the original primary relocation site, she said.
The local department also is responsible for any follow-up screenings and treatments necessary — including those for tuberculosis — beyond the initial examinations.
Q Is Emporia equipped to handle an outbreak of diseases commonly associated with third-world countries?
A “I guess that answer to ‘Are we prepared to deal with that?’ was, I think, demonstrated by the way the January case was handled, where within a relatively short period of time we had completed the contacts, followed-up, and identified no more active cases,” she said. “But if there had been active cases related to that, that sort of baseline case, we would have identified them. So, that’s the way in which you manage and control an outbreak, so to speak.”
Medical professionals from the department contacted all of the co-workers, family members and friends with whom the victim had close contact and, through testing that included rudimentary tests as well as X-rays, verified that none of them had active TB.
Marsh said that TB is passed along by prolonged, close contact with the carrier. Casual contact “would not put you at risk,” she said.
Many of the other diseases that may occur in the refugees’ homeland might not necessarily be issues in the United States.
“I think most of those are more environmentally generated,” Marsh said.
Renee Hively, public health manager for the center, agreed. Tuberculosis is the main concern and a process is in place to test and treat those diagnosed with latent or active TB.
Diseases like hepatitis, AIDS, and human immuno-deficiency virus are blood-borne and medical professionals have the means to deal with those.
Many of the other disease are indigenous to certain areas of the world, but not likely to be seen in the United States.
Cholera, for example, is transmitted in contaminated water and by improper cooking.
“We’re not in a third-world country, so we have good preventive measures in place,” Hively said.
Refugees are checked for parasites when they come over and are treated, if necessary.
“They’re usually vaccinated by the time they get here, too; that’s part of the requirements coming in,” she said, adding that Americans and others living in this country also should have been vaccinated against some of the diseases. “At this point I can’t think of anything (else) that we would need to be concerned with.”
The department is prepared with protocols to handle outbreaks, from flu to tuberculosis.
“Every disease outbreak, our main goal is containment,” she said.
Q Why are so many Somalis using the Flint Hills Community Health Center when they have jobs at Tyson? Doesn’t Tyson offer health insurance to Somalis as it does to other workers?
A The health center is open to all in the service area, including Somalis who do have health insurance through Tyson.
“ ... (A)nyone can come to the Flint Hills Community Health Center to seek services and health care because we serve people with insurance just as we serve people without health insurance,” Marsh said. “We’re billing their insurance for any services that they receive here and that’s a good thing for us as an organization. That helps to sort of round out our revenue stream.”
Q How much more is it costing Lyon County to test and treat the refugees? What’s been added to the budget because of that?
A “Nothing has been added to our budget because of that in terms of anything that’s being supported by Lyon County,” she said. “We have added a couple of positions but we are just having to fit that into our overall financial picture because ... these positions were not specifically funded by Lyon County.”
Additional funds have been provided through a larger pool of taxpayers at the state and/or federal level.
“We have received $5,000 from the state for our tuberculosis program, so that helps with some of the testing costs that are involved,” Marsh said.
Insurance payments are covering the costs of the Somalis who have been employed long enough to qualify for health benefits.
Hively said she believed that TB may have reached a plateau in this area. Because many of the refugees are a transient population, some of the follow-up cannot be completed here.
“And actually, we’ve been really good about giving them all the information they need to take with them,” Hively said, “so the next health department, it will be a lot easier than it was when they came here.”
Hively said that the refugees talk to each other about the requirements for health.
“They educate their people pretty well about what they need and where to get records and everything else,” she said.
Q How many cases of TB are there in Lyon County?
A A total of 143 latent cases of TB were reported as treated or being treated in 2006 and 237 cases in 2007. The 2007 figure includes a carryover of 50 whose nine-month treatment was continued from 2006.
Of the 380 total cases from those years, 136 have completed their treatment, 117 cases have been closed out to follow-up because the patients have moved on with their records to health departments in other areas, and 127 cases remain open and receiving treatment, according to figures supplied by Hively.
In 2006, three active cases of TB were reported in Lyon County, and one patient with active TB was diagnosed in Minnesota and completed treatment here.
One active case was reported in 2007 “and that case is not in a Somali person,” Hively said.
She added that active TB also was discovered in a Somali who died early in 2007. The TB was listed as a contributing cause of death.
In 2005 and prior years, the county averaged about 30 cases of latent TB and at least one active case of TB per year, she said.
• To post comments about this story, go to the Refugee Resettlement forum at http://www.emporiagazette.com/forums/open/News/15/